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  Sinusitis   Sinusitis , also known as rhinosinusitis , is inflammation of the paranasal sinuses. It can be due   to infection, allergy, orautoimmune problems. Most cases are due to a viral infection and resolve over the course of 10 days. It is a common condition, with over 24 million cases annually in the U.S. [1]   Classification  Sinusitis (or rhinosinusitis) is defined as an inflammation of the mucous membrane that lines the paranasal sinuses and is classified chronologically into several categories: [2]      Acute rhinosinusitis —  a new infection that may last up to four weeks and can be subdivided symptomatically into severe and non-severe;    Recurrent acute rhinosinusitis —  four or more separate episodes of acute sinusitis that occur within one year;    Subacute rhinosinusitis —  an infection that lasts between four and 12 weeks, and represents a transition between acute and chronic infection;    Chronic rhinosinusitis —  when the signs and symptoms last for more than 12 weeks; and    Acute exacerbation of chronic rhinosinusitis —  when the signs and symptoms of chronic rhinosinusitis exacerbate, but return to baseline after treatment. All these types of sinusitis have similar symptoms, and are thus often difficult to distinguish. Acute sinusitis is very common. Roughly ninety percent of adults have had sinusitis at some point in their life. [3]   Acute Acute sinusitis is usually precipitated by an earlier upper respiratory tract infection, generally of  viral srcin, mostly caused by rhinoviruses, coronaviruses, andinfluenza viruses, others   caused by adenoviruses, human parainfluenza viruses, human respiratory syncytial   virus, enteroviruses other than rhinoviruses, andmetapneumovirus. If the infection is of bacterial srcin, the most common three causative agents are  Streptococcus    pneumoniae ,  Haemophilus influenzae , and Moraxella catarrhalis . [4]  Until recently,  Haemophilus   influenzae  was the most common bacterial agent to cause sinus infections. However, introduction of the H. influenza  type B (Hib) vaccine has dramatically decreased H. influenza  type B infections and now non-typable H. influenza  (NTHI) are predominantly seen in clinics. Other sinusitis-causing bacterial pathogens include  Staphylococcus aureus  and   other streptococci species, anaerobic bacteria and, less commonly, gram negativebacteria. Viral sinusitis typically lasts for 7 to 10 days, [4]  whereas bacterial sinusitis is more persistent. Approximately 0.5% to 2% of viral sinusitis results in subsequent bacterial sinusitis. It is thought that nasal irritation from nose blowing leads to the secondary bacterial infection. [5]  Acute episodes of sinusitis can also result from fungal invasion. These infections are typically   seen in patients with diabetes or other immune deficiencies (such   asAIDS or transplant patients on immunosuppressive anti-rejection medications) and can be  life-threatening. In type I diabetics, ketoacidosis can be associated with sinusitis due to mucormycosis. [6]  Chemical irritation can also trigger sinusitis, commonly from cigarette smoke and chlorine fumes. [7]  Rarely, it may be caused by a tooth infection. [4]   Chronic By definition chronic sinusitis lasts longer than three months and can be caused by many different diseases that share chronic inflammation of the sinuses as a common symptom. Symptoms of chronic sinusitis may include any combination of the following: nasal congestion,    facial pain, headache, night-time coughing, an increase in previously minor or controlled asthma symptoms, general malaise, thick green or yellow discharge, feeling of facial 'fullness' or   'tightness' that may worsen when bending over, dizziness, aching teeth, and/or halitosis. [2]  Each of these symptoms has multiple other possible causes, which should be considered and investigated as well. Often chronic sinusitis can lead to anosmia, a reduced sense of  smell. [2]  In a small number of cases, acute or chronic maxillary sinusitis is associated with a dental   infection. Vertigo, lightheadedness, and blurred vision are not typical in chronic sinusitis and   other causes should be investigated. [ citation needed  ]  Chronic sinusitis cases are subdivided into cases with polyps and cases without polyps. When   polyps are present, the condition is called chronic hyperplastic sinusitis; however, the causes are poorly understood [4]  and may include allergy, environmental factors such as dust or pollution, bacterial infection, or fungus (either allergic, infective, or reactive). Chronic rhinosinusitis represents a multifactorial inflammatory disorder, rather than simply a persistent bacterial infection. [4]  The medical management of chronic rhinosinusitis is now focused upon controlling the inflammation that predisposes patients to obstruction, reducing the incidence of infections. However, all forms of chronic rhinosinusitis are associated with impaired sinus drainage and secondary bacterial infections. Most individuals require initial antibiotics to clear any infection and intermittently afterwards to treat acute exacerbations of chronic rhinosinusitis. A combination of  anaerobic and aerobic bacteria, are detected in conjunction with chronic   sinusitis. Also isolated are  Staphylococcus aureus  (including methicilin resistant S.aureus  ) and coagulase-negative  Staphylococci   and Gram negative enteric organisms can be isolated.   Attempts have been made to provide a more consistent nomenclature for subtypes of chronic sinusitis. The presence of  eosinophils in the mucous lining of the nose and paranasal sinuses has been demonstrated for many patients, and this has been termed eosinophilic mucin  rhinosinusitis (EMRS). Cases of EMRS may be related to an allergic response, but allergy is not often documented, resulting in further subcategorization into allergic and non-allergic EMRS. [8]  A more recent, and still debated, development in chronic sinusitis is the role that fungi play in   this disease. It remains unclear if fungi are a definite factor in the development of chronic sinusitis and if they are, what the difference may be between those who develop the disease and those who remain free of symptoms. Trials of antifungal treatments have had mixed results. By location There are several paired paranasal sinuses, including the frontal, ethmoidal, maxillary and sphenoidal sinuses. The ethmoidal sinuses is further subdivided into anterior and posterior ethmoid sinuses, the division of which is defined as the basal lamella of the middle turbinate. In addition to the severity of  disease, discussed below, sinusitis can be classified by the sinus cavity which it affects:    Maxillary   –  can cause pain or pressure in the maxillary (cheek) area   ( e.g.,  toothache, [9]  or headache) (J01.0/J32.0)      Frontal   –  can cause pain or pressure in the frontal sinus cavity (located above eyes), headache, particularly in the forehead (J01.1/J32.1)      Ethmoidal   –  can cause pain or pressure pain between/behind the eyes, the sides of the   upper part of the nose (the medial canthi), and headaches (J01.2/J32.2) [10]      Sphenoidal   –  can cause pain or pressure behind the eyes, but often refers to the   skull vertex (top of the head), over the mastoid processes, or the occiput (back of the   head). [10]  Recent theories of sinusitis indicate that it often occurs as part of a spectrum of  diseases that affect the respiratory tract ( i.e. , the one airway theory) and is often linked to asthma. [11][12]  All   forms of sinusitis may either result in, or be a part of, a generalized inflammation of the airway,    so other airway symptoms, such as cough, may be associated with it. Signs and symptoms [edit]   Headache/facial pain or pressure of a dull, constant, or aching sort over the affected sinuses is common with both acute and chronic stages of sinusitis. This pain is typically localized to the involved sinus and may worsen when the affected person bends over or when lying down. Pain   often starts on one side of the head and progresses to both sides. [13]  Acute and chronic sinusitis may be accompanied by thick nasal discharge that is usually green in color and may contain pus (purulent) and/or blood. [14]  Often a localized headache or toothache is present, and it is these
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